RESUMO
BACKGROUND/AIMS: Although a potassium-competitive acid blocker (PCAB)-based regimen improves the rate of successful Helicobacter pylori first-line eradication, the efficacy of a PCAB-based regimen as second-line therapy is unclear. The aim of this study is to compare the success of second-line eradication of H. pylori using PCAB and proton pump inhibitor (PPI)-based regimens. METHODS: From 2014 to 2017, 624 patients who underwent second-line H. pylori eradication were enrolled. A standard triple regimen for second-line H. pylori eradication includes metronidazole 250 mg, amoxicillin 750 mg, and PPI or PCAB twice daily for 7 days. The success of eradication was compared using intention-to-treat, per-protocol, and propensity-score matching analysis. RESULTS: All patients completed the 7-day course of therapy. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen in both intention-to-treat (90% [298/330] vs. 85% [250/294], p = 0.045) and per-protocol analyses (96% [298/309] vs. 91% [250/274], p = 0.008). Adverse events occurred in 4 patients. Propensity score matching analysis acquired 274 matched pairs. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen (96% [264/274] vs. 91% [250/274], p = 0.013). CONCLUSIONS: PCAB-based second-line H. pylori eradication is significantly better than PPI-based therapy.
Assuntos
Antiácidos/administração & dosagem , Antibacterianos/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/isolamento & purificação , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antiácidos/efeitos adversos , Antibacterianos/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Endoscopia do Sistema Digestório , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Humanos , Masculino , Metronidazol/administração & dosagem , Metronidazol/efeitos adversos , Pessoa de Meia-Idade , Potássio/metabolismo , Pontuação de Propensão , Inibidores da Bomba de Prótons/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A 40-year-old man with refractory ulcerative colitis (UC) was treated with tumor necrosis factor α inhibitor (anti-TNFα), infliximab. One month later, the chest computed tomography and laboratory test showed noninfectious interstitial lung disease (ILD) and elevation of serum Krebs von den Lungen-6 (KL-6). Fortunately, ILD disappeared after the discontinuation with anti-TNFα. Two and a half years after his first UC treatment, he was treated again with another anti-TNFα, adalimumab, for relapse and he had a second ILD. This course suggested anti-TNFα induced ILD. The characteristics of anti-TNFα-induced ILD in inflammatory bowel disease (IBD) are not well understood. We summarized and investigated the characteristics of such patients based on a literature review including 15 cases. It suggested that anti-TNFα-induced ILD in IBD might be rare and tends to have a better outcome compared with ILD in rheumatoid arthritis.
RESUMO
BACKGROUND AND STUDY AIMS: Despite widespread use of cold snare polypectomy (CSP), the R0 resection rate is not well documented. We perform extended CSP, resecting polyps with a >â1âmm circumferential margin. The aim of this study is to compare the R0 resection rate of extended CSP with conventional CSP and to assess safety. PATIENTS AND METHODS: From April 2014 to September 2016, 712 non-pedunculated colorectal polyps,â<â10âmm in size, resected using CSP from 316 patients were retrospectively analyzed. RESULTS: We divided lesions into conventional CSP (nâ=â263) and extended CSP groups (nâ=â449). The baseline characteristics of these two groups were not significantly different in univariate or multivariate analyses. Sessile polyps comprised 94â% (668/712), and the remaining were flat-elevated polyps. Mean size of polyps (±standard deviation) was 4.2â±â1.5âmm. The most frequent pathology was low grade adenoma (97â%, 689/712). The R0 resection rate was significantly higher in the extended CSP group (439/449 [98â%]) than in the conventional CSP group (222/263 [84â%], P â<â0.001). There was no delayed bleeding or perforation in either group (conventional CSP group, 0/263, 95â% confidence interval: 0.0â-â1.4â% and extended CSP group, 0/449, 95â% confidence interval: 0.0â-â0.8â%). CONCLUSIONS: Extended CSP results in a higher R0 resection rate compared with conventional CSP. Extended CSP did not result in a higher rate of delayed bleeding or perforation. Extended CSP is a safe and promising procedure for endoscopic resection of non-pedunculated colorectal polyps < 10âmm in size.